Life after heart valve replacement. Types of artificial valves, their features

Heart valve replacement has been carried out everywhere for many years and has proven itself to be a safe and very effective operation for restoring normal hemodynamics in the heart and the body as a whole.

During life, the valves remain in permanent job, opening and closing billions of times. By old age, some wear and tear of their tissues may occur, but the degree does not reach critical levels. Much greater damage to the condition of the valve apparatus is caused by various diseases - atherosclerosis, rheumatic endocarditis, bacterial infection valves

Valvular lesions are most common among older people, the reason for which is atherosclerosis, accompanied by the deposition of fat and protein masses in the valves, their compaction, and calcification. The continuously relapsing nature of the pathology causes periods of exacerbations with damage to valve tissue, microthrombosis, ulceration, which are followed by subsidence and sclerosis. Sprawl connective tissue ultimately leads to deformation, shortening, thickening and decreased mobility of the valve leaflets - a defect is formed.

Among young patients requiring artificial valve transplantation, mainly patients rheumatism. The infectious-inflammatory process on the valves is accompanied by ulceration and local thrombosis ( verrucous endocarditis), necrosis of the connective tissue that forms the basis of the valve. As a result of irreversible sclerosis, the valve changes its anatomical configuration and becomes unable to perform its function.

Defects of the valvular apparatus of the heart lead to a total disruption of hemodynamics in one or both circulation circles. When these openings are narrowed (stenosis), the cavities of the heart do not fully empty, which are forced to work harder, hypertrophying, then depleting and expanding. In case of valve insufficiency, when the valve flaps do not close completely, part of the blood returns in the opposite direction and also overloads the myocardium.

An increase in heart failure, stagnation in the large or small circle of blood flow provoke secondary changes in internal organs, and are also dangerous for acute heart failure, therefore, if measures are not taken in time to normalize intracardiac blood flow, the patient will be doomed to death from decompensated heart failure.

The traditional valve replacement technique involves open access to the heart and temporarily removing it from circulation. Today, more gentle, minimally invasive methods are widely used in cardiac surgery. surgical correction, which are less risky and just as effective as open surgery.

Modern medicine offers not only alternative methods of operations, but also more modern designs of the valves themselves, and also guarantees their safety, durability and full compliance with the requirements of the patient’s body.

Indications and contraindications for heart valve replacement

Heart operations, no matter how they are performed, carry certain risks, are technically complex and require the participation of highly qualified cardiac surgeons working in a well-equipped operating room, so they are not simply performed. If there is a heart defect, the organ itself copes with it for some time. increased load, as his functional abilities weaken, drug therapy is prescribed, and only if conservative measures are ineffective does the need for surgery arise. Indications for heart valve replacement include:

Thus, the reason for surgical correction becomes any irreversible structural change constituent parts valve, making correct unidirectional blood flow impossible.

There are also contraindications to heart valve replacement surgery. Among them - serious condition patient, pathology of other internal organs that make the operation dangerous to the patient’s life, severe blood clotting disorders. An obstacle to surgical treatment The patient may refuse surgery, as well as neglect of the defect, when intervention is inappropriate.

The mitral and aortic valves are most often replaced; they are also usually affected by atherosclerosis, rheumatism, and bacterial inflammation.

Depending on the composition, the heart valve prosthesis can be mechanical or biological. Mechanical valves made entirely of synthetic materials, they are metal structures with semicircular doors moving in one direction.

The advantages of mechanical valves are considered to be their strength, durability and wear resistance; the disadvantages are the need for lifelong anticoagulant therapy and the possibility of implantation only with open access to the heart.

Biological valves consist of animal tissues - elements of the bovine pericardium, pig valves, which are fixed on a synthetic ring that is installed at the attachment point of the heart valve. Animal tissues are processed in the manufacture of biological prostheses special compounds, preventing immune rejection after implantation.

The advantages of a biological artificial valve are the possibility of implantation during endovascular intervention, limiting the period of taking anticoagulants within three months. A significant disadvantage is considered to be rapid wear, especially if the mitral valve is replaced with such a prosthesis. On average, a biological valve lasts about 12-15 years.

The aortic valve is easier to replace with any type of prosthesis than the mitral valve, so if it is damaged mitral valve first resort to different types plastic surgery (commissurotomy), and only if they are ineffective or impossible is the possibility of a total valve replacement considered.

Preparing for valve replacement surgery

Preparation for surgery begins with thorough examination, including:

1. General and biochemical blood tests;
2. Urine examination;
3. Determination of blood clotting;
4. Electrocardiography;
5. Ultrasound examination of the heart;
6. Chest X-ray.

Depending on the accompanying changes, the list of diagnostic procedures may include coronary angiography, vascular ultrasound, and others. Consultations required narrow specialists, conclusions of a cardiologist and therapist.

On the eve of the operation, the patient talks with the surgeon, anesthesiologist, takes a shower, has dinner - no later than 8 hours before the start of the intervention. It is advisable to calm down and get some sleep; many patients benefit from talking with the attending physician, clarifying all questions of interest, knowing the technique of the upcoming operation and getting to know the staff.

Technique for heart valve replacement surgery

Heart valve replacement can be performed through an open approach and in a minimally invasive manner without an incision in the sternum. Open surgery carried out under general anesthesia. After immersing the patient in anesthesia, the surgeon processes the surgical field - the anterior surface of the chest, dissects the sternum in the longitudinal direction, opens the pericardial cavity, followed by manipulations on the heart.

A device is used to disconnect the organ from the bloodstream. cardiopulmonary bypass, which allows valves to be implanted on a failing heart. In order to prevent hypoxic damage to the myocardium, it is treated with cold saline throughout the entire operation.

To install the prosthesis, the desired cavity of the heart is opened using a longitudinal incision, the altered structures of the native valve are removed, in place of which an artificial one is installed, after which the myocardium is sutured. The heart is “started” using an electrical impulse or direct massage, and artificial circulation is turned off.

Once artificial heart valve installed, and the heart is sutured, the surgeon examines the cavity of the pericardium and pleura, removes blood and sutures it layer by layer surgical wound. Metal staples, wire, and screws can be used to connect the halves of the sternum. Regular sutures or cosmetic intradermal sutures with self-absorbable threads are applied to the skin.

Open surgery is very traumatic, so the operational risk is high, and post-operative recovery takes a long time.

Endovascular technique valve replacement shows very good results, it does not require general anesthesia, so it is quite feasible for patients with severe concomitant diseases. The absence of a large incision makes it possible to reduce hospital stay and subsequent rehabilitation to a minimum. An important advantage of endovascular prosthetics is the ability to perform surgery on a beating heart without the use of a heart-lung machine.

During endovascular prosthetics, a catheter with an implantable valve is inserted into the femoral vessels (artery or vein, depending on which cavity of the heart needs to be penetrated). After destruction and removal of fragments of the own damaged valve, a prosthesis is installed in its place, which itself straightens thanks to a flexible stent frame.

After valve installation, stenting can also be performed. coronary vessels. This opportunity is very relevant for patients whose valves and vessels are affected by atherosclerosis, and in the process of one manipulation two problems can be solved at once.

The third option for prosthetics is from a mini-access. This method is also minimally invasive, but an incision of about 2-2.5 cm is made on the anterior chest wall in the projection of the apex of the heart, and a catheter is inserted through it and the apex of the organ to the affected valve. Otherwise, the technique is similar to that for endovascular prosthetics.

In many cases, heart valve transplantation is an alternative to heart transplantation, which can significantly improve well-being and increase life expectancy. Select one of the listed methods The operation and type of prosthesis depends on both the patient’s condition and the technical capabilities of the clinic.

Open surgery is the most dangerous, and the endovascular technique is the most expensive, but, having significant advantages, it is the most preferable for both young and elderly patients. Even if there are no specialists or conditions for endovascular treatment in a particular city, but the patient has the financial opportunity to go to another clinic, then it is worth taking advantage of it.

If aortic valve replacement is necessary, mini-access and endovascular surgery are preferred, while mitral valve replacement is more often performed open method due to the peculiarities of its location inside the heart.

Postoperative period and rehabilitation

The operation to replace a heart valve is very painstaking and time-consuming, lasting at least two hours. After its completion, the operated patient is placed in the intensive care unit for further observation. After 24 hours and if the patient’s condition is favorable, the patient is transferred to a regular ward.

After open surgery, the sutures are processed daily and removed within 7-10 days. This entire period requires hospitalization. With endovascular surgery, you can go home within 3-4 days. Most patients note rapid improvement well-being, a surge of strength and energy, ease in performing ordinary everyday activities - eating, drinking, walking, showering, which previously provoked shortness of breath and severe fatigue.

If during prosthetics there was an incision in the sternum area, then the pain can be felt for quite a long time - up to several weeks. With strong unpleasant sensations You can take an analgesic, but if swelling, redness progresses in the suture area, and pathological discharge appears, then you should not hesitate to visit a doctor.

The rehabilitation period takes on average about six months, during which the patient regains strength, physical activity, gets used to taking certain medications (anticoagulants) and regular monitoring of blood clotting. It is strictly prohibited to cancel, independently prescribe or change the dosage of drugs; this should be done by a cardiologist or therapist.

Drug therapy after valve replacement includes:

Anticoagulants with an implanted mechanical valve help avoid thrombus formation and embolism, which are provoked by a foreign body in the heart, but there are also by-effect taking them - there is a risk of bleeding, stroke, therefore Regular monitoring of INR (2.5-3.5) is an indispensable condition for life with a prosthesis.

Among the consequences of transplantation of artificial heart valves, the greatest danger is thromboembolism, which is prevented by taking anticoagulants, as well as bacterial endocarditis - inflammation of the inner layer of the heart, when the prescription of antibiotics is mandatory.

During the rehabilitation stage, some disturbances in well-being are possible, which usually disappear after several months - six months. These include depression and emotional lability, insomnia, temporary visual disturbances, discomfort in the chest and postoperative suture area.

Life after surgery, subject to successful recovery, is no different from that of other people: the valve works well, the heart too, there are no signs of its failure. However, having a prosthesis in the heart will require changes in lifestyle, habits, regular visits to a cardiologist and monitoring of hemostasis.

The first follow-up examination by a cardiologist is carried out approximately a month after prosthetics. At the same time, blood and urine tests are taken, and an ECG is taken. If the patient’s condition is good, then in the future the doctor should be visited once a year, in other cases – more often, depending on the patient’s condition. If you need to undergo other types of treatment or examinations, you should always warn in advance about the presence of a prosthetic valve.

Lifestyle after valve replacement requires giving up bad habits. First of all, you should stop smoking, and it is better to do this even before surgery. The diet does not dictate significant restrictions, but it is better to reduce the amount of salt and liquid consumed so as not to increase the load on the heart. In addition, you should reduce the proportion of foods containing calcium, as well as the amount of animal fats, fried foods, and smoked foods in favor of vegetables, lean meats and fish.

High-quality rehabilitation after heart valve replacement is impossible without adequate motor activity. Exercises help improve overall tone and train the cardiovascular system. In the first weeks, you should not be too zealous. It is better to start with feasible exercises that will prevent complications without overloading the heart. Gradually the volume of loads can be increased.

To physical activity did not do any harm, experts recommend undergoing rehabilitation in sanatoriums, where exercise therapy instructors will help form individual program physical education. If this is not possible, then all questions regarding sports activities will be explained by a cardiologist at your place of residence.

The prognosis after artificial valve transplantation is favorable. Within a few weeks, health is restored and patients return to ordinary life and work. If work activity associated with intense loads, then a transfer to lighter work may be required. In some cases, the patient receives a disability group, but it is not related to the operation itself, but to the functioning of the heart as a whole and the ability to perform one or another type of activity.

Feedback from patients after heart valve replacement surgery is often positive. The duration of recovery is different for everyone, but most note positive dynamics already in the first six months, and relatives are grateful to the surgeons for the opportunity to prolong life to a loved one. Relatively young patients feel well; some, they say, even forget about the presence of a valve prosthesis. It is more difficult for older people, but they also note significant improvement.

Heart valve transplantation can be done free of charge, at government expense. In this case, the patient is put on a waiting list, and preference is given to those who need surgery urgently or urgently. Paid treatment is also possible, but, of course, it is not cheap. The valve itself, depending on the design, composition and manufacturer, can cost up to one and a half thousand dollars, the operation starts from 20 thousand rubles. The upper threshold for the cost of the operation is difficult to determine: some clinics charge 150-400 thousand, in others the price of the entire treatment reaches one and a half million rubles.

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When is mitral valve surgery necessary?

It is carried out in case of severe valve defects that lead to circulatory disorders, in the absence of effect from therapeutic treatment and the inability to correct valve defects with surgery.

Indications for the operation:

Read also: Coronary artery bypass surgery: indications, stages, complications of the operation, video

Stages of prosthetic surgery

Mitral valve replacement surgery carried out under general anesthesia, most often on open heart. Average duration surgical intervention - about 6 hours.

Main stages surgery for mitral valve replacement:

Features of the postoperative period - rehabilitation and possible consequences

After surgical intervention For mitral valve replacement, patients spend several days in the hospital. In the future, they need outpatient monitoring, taking certain medications, and doing therapeutic exercises. In the first few weeks after surgery, you may experience fatigue and chest pain.

Possible complications after valve replacement:

• Thromboembolism. To prevent this complication, anticoagulant therapy is indicated.
• Infectious endocarditis. Prevention of complications - antibiotic therapy.

As a rule, 6 months after surgery, subject to the recommendations and prescriptions of the attending physician, the patient can return to normal image life.

Read also: Stages of heart transplant with comments, photos and videos

Life after heart mitral valve replacement

After valve replacement surgery, it is recommended to adhere to the following healthy lifestyle principles:

• Stop smoking and drinking alcoholic beverages.
• Do physical therapy.
• Avoid stress.
• Follow a diet.

Diet after mitral valve replacement surgery is to refuse fatty foods, preference must be given vegetable fats in small quantities. It is also recommended to reduce the consumption of salt and foods containing calcium.

Review of offers and approximate prices for heart valve replacement in Moscow and St. Petersburg

Mitral valve replacement can be done in the following medical institutions in Moscow and St. Petersburg:

• Institute of Surgery named after. A.V. Vishnevsky.
• Clinical Hospital No. 119, Moscow.
• NMHC named after. Pirogov.
• KB MSMU im. Sechenov.
• Clinical Hospital No. 83, Moscow.
• Clinic JSC "Medicine".
• St. Petersburg State Healthcare Institution “GB No. 40 of the Kurortny Administrative District”.
• Clinical Hospital No. 122 named after. L. G. Sokolova.
• Clinic of St. Petersburg State Medical University named after. acad. I. P. Pavlova.
• Leningrad Regional Clinical Hospital.
• American medical clinic.

The cost of surgery to replace the mitral valve ranges from 90,000 rubles to 420,000 rubles.

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Basic moments

The heart valve is an element of the internal heart frame, which represents folds of connective tissue. The operation of the valves is aimed at delimiting the amount of blood in the ventricles and atria, which allows the chambers to take turns resting after blood is displaced during contraction.

If according to various reasons the valve fails to cope with its function, and intracardiac hemodynamics are disrupted. Therefore, the heart muscle gradually ages, and cardiac inferiority occurs. In addition, blood cannot circulate normally throughout the body due to disruption of the pumping function of the heart, causing blood to stagnate in the organs. This applies to the kidneys, liver, and brain.

Not treating stagnant manifestations contributes to the development of the disease of all human organs ultimately to death. Based on this, valve pathology is a very dangerous problem that requires cardiac surgery.

The following types of surgical intervention are distinguished:

• plastic;
• valve replacement.

Plastic surgery consists of restoring the valve on the support ring. Surgery is used for heart valve insufficiency.

Prosthetics involves complete replacement of the valve. The mitral and aortic heart valves are often replaced.

When is the operation performed?

The operation is prescribed in case of severe valve damage with the development of heart disease, which has a significant impact on hemodynamics.

The development of valve defects occurs due to rheumatism. It belongs to one of the forms streptococcal infection and is characterized by damage to the heart and joints. Rheumatism often occurs after frequent illnesses sore throat, chronic tonsillitis.

Valve replacement occurs based on the degree of heart failure, data provided by echocardioscopy.

The operation is prescribed in the following cases:

• aortic valve stenosis, which is represented by symptoms such as fainting, chest pain, shortness of breath;
• clinical manifestation of aortic stenosis in patients who have undergone coronary artery bypass grafting;
• severe heart failure, characterized by shortness of breath with little activity or rest, severe swelling of the extremities, facial area, body, moderate, pronounced mitral valve stenosis;
• symptoms of heart failure initial stage development – ​​shortness of breath during strong physical exertion, impaired heartbeat in patients with mild mitral valve stenosis;
• endocarditis is one of the factors of valve damage.

Cannot be carried out surgical intervention

The operation is contraindicated due to a number of diseases:

• acute myocardial infarction;
• blood flow disorders in the brain acute form(stroke);
• infectious diseases, fever;
• the course of chronic diseases (bronchial asthma, diabetes mellitus) has worsened and worsened;
• severe form of heart failure, ejection fraction, which with mitral stenosis is less than 20%.

Stages of prosthetics

The operation is performed under general anesthesia, often with an open heart. Surgery takes on average 6 hours.

Stages of the operation.

1. The surgeon makes a large incision in the chest (median stenotomy).
2. The patient is connected to a heart-lung machine.
3. The process of cooling the heart occurs, the heartbeat slows down to a minimum.
4. The doctor removes the mitral valve that has become damaged.
5. The implant is installed. The mechanical prosthesis is durable and does not require replacement. It has the disadvantage of increasing the prothrombin level in circulatory system, contribute to the formation of blood clots. The biological valve must be replaced after 10 - 15 years due to wear and tear.
6. The seams are being adjusted.
7. Step-by-step disconnection of the patient from the device.

This operation is common in the treatment of cardiac stenosis. If the surgical intervention is successful and the patient’s recovery proceeds without complications, then in the near future the patient will be able to forget about the cardiac problem.

The only reminder after heart surgery will be the scar.

Recovery postoperative period

After completion of the operation, the patient remains in the intensive care unit. After recovering from anesthesia, the patient's breathing tube is removed from the lungs. The tube may be left in place for a while to drain excess fluid from the lungs.

The day after surgery, the patient can eat solid food. After 2 days, you are allowed to get up and walk. For some time, you may feel chest pain. Based on the general condition of the patient, discharge occurs on 4-5 days.

Possible consequences after valve replacement

Heart surgery is a complex surgical procedure that can lead to complications and unexpected problems.

1. Proliferation of scar tissue.
2. Bleeding after taking anticoagulants.
3. Thromboembolism.
4. Infection of the replaced valve.
5. Hemolytic anemia.

Some patients experience rapid growth of fibrous scar tissue at the site of the prosthesis. This process occurs as a result of a implanted biological or transplanted mechanical valve. This complication contributes to the formation of implant thrombosis and requires urgent reoperation.

Anticoagulants are drugs that thin the blood. They do not make the blood liquid, but do not allow blood clots to form and increase the clotting time of the blood. Therefore, the work of anticoagulants is aimed at removing the formed blood clot from the valve before it transforms into a thrombus.

There are cases that when taking anticoagulants, patients experience bleeding in other organs, often the stomach. Based on this, patients are advised to control the color of urine and excrement. If there is bleeding, the color changes to dark. If you experience any signs of an unfavorable stomach condition, you should consult a specialist.

A serious postoperative complication is thromboembolism, which causes thrombosis. Symptoms of thrombosis include:

• shortness of breath;
• dizziness;
• clouding of mind;
• loss of vision, hearing;
• weakness, numbness of the whole body.

If any of the signs occur, you should immediately seek medical help.

Placing any foreign sterile object into the human body can lead to infection. Therefore, in case of an increase in temperature or prolonged respiratory diseases, it is necessary to visit a doctor. Based on the tests performed, the cause of the corresponding symptoms will be determined. Either the artificial prosthesis became infected or there was another factor.

People with an artificial prosthesis, when visiting the dentist, undergoing colonoscopy, gastroscopy, angiography, in order to avoid infection of the prosthesis, need to tell doctors about the presence of an artificial heart valve. In addition, avoid infection of the skin if there are wounds, cuts, blisters, or abrasions.

Quite rarely occurs hemolytic anemia. With anemia, a person feels weak and fatigue does not go away. The symptoms are very similar when taking anticoagulants, but complications in this case arise and develop in completely different ways.

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Unfortunately, there are not enough pictures, but I had an operation similar to this.
The doctor said that there is an even more interesting article on this topic on the Internet, but I’ve been digging for three days now and haven’t found it yet.

Aortic valve stenosis – surgery
If you are experiencing symptoms of aortic valve stenosis, your doctor will recommend valve replacement surgery, unless there are conditions in which surgery is risky. Symptoms such as chest pain, fainting and difficulty breathing indicate significant narrowing of the aortic valve. Without valve replacement surgery, life expectancy is significantly reduced. In rare cases, sudden death may occur.

Heart valve replacement surgery is advanced surgical procedure with a high percentage of effectiveness and a low percentage of complications.

Aortic valve replacement

Aortic valve replacement surgery is an operation open type, which can also be performed using minimally invasive surgery. During the procedure, the damaged valve is removed and replaced with an artificial one (mechanical or biological) *. There are several types of artificial valves.

In some cases, one of the other heart valves may be used as a prosthetic aortic valve. For this purpose, as a rule, a pulmonary valve is used, located between the right lower chamber of the heart and the opening pulmonary artery. The pulmonary valve is replaced with an artificial one. This type of valve is suitable for people under 25 years of age for whom this complex operation is the most acceptable. The pulmonary valve is more durable, grows with the person, and the risk of infectious disease is lower.

Aortic valve replacement surgery can be risky due to conditions such as a weak left ventricle, coronary artery disease, or a previous heart attack.

IN Lately questioning the advisability of aortic valve replacement in the absence of symptoms of stenosis. Although there is no research data to support the effectiveness of this approach, some experts believe that aortic valve repair or replacement surgery should be performed immediately after identification of the aortic valve. severe symptoms stenosis due to the likelihood of sudden death.

According to other experts, surgery is only necessary if the symptoms of the stenosis progress, since the risk of sudden death is lower compared to the risk of surgery. If surgery is delayed, regular examination (including cardiogram) is necessary to monitor changes in valve structure and heart function. These tests will help determine when to have surgery.

In general, if severe symptoms of stenosis are present, postponing surgery will be riskier than the surgery itself. Without aortic valve replacement, most people with severe stenosis die within 2.5 years.

Impaired left ventricular function and low local ejection fraction limit the possibility of surgery in people with severe aortic valve stenosis.

However, according to the results of one study, for people who were at risk, aortic valve replacement surgery gave positive results. Valve replacement surgery also poses a risk for people with coronary artery disease and those who have had a heart attack.

Before valve replacement surgery, your doctor may order a coronary angiogram or coronary catheterization. This test can show the presence of blockage in the coronary arteries (evidence coronary disease hearts). If the blockage is severe, your doctor may prescribe surgery. coronary bypass surgery simultaneously with heart valve replacement surgery.

Other types of aortic valve replacement surgery

A surgical procedure such as balloon valvuloplasty may be the best option for young people with aortic valve stenosis. During the procedure, instead of replacing the heart valve, the artery is widened.

How is heart valve replacement surgery performed?

Heart valve replacement surgery is an open procedure performed in a hospital operating room. The operation can also be performed using minimally invasive surgery.

Despite the complexity of the heart valve replacement procedure, this operation is performed quite often. The operation is carried out using the latest technologies, has a high percentage of effectiveness and a low percentage of risk. The operation is performed by a cardiac surgeon - a specialist in heart surgery who has many years of experience performing such operations. A team of nurses, an anesthesiologist, and possibly a resident physician also participate in the operation.

Valve replacement surgery ( open surgery on the heart) occurs in eight stages:

Step 1: Preparing for surgery

Valve replacement surgery requires the same preparations as other major surgeries. You will not need to eat food for 12 hours before surgery to prevent vomiting during anesthesia. You will also need to temporarily stop taking certain medications.

During surgery, you will be attached to heart monitors, including a cardiograph, to monitor your heart function and other important vital signs. The nurse will also provide you with an IV to administer solutions and necessary medications. Finally, the nurse will cover the surgical site with sterile drapes and, if necessary, shave your chest to ensure the surgical area is sterile.

During the operation, you will breathe using a respirator - a tube will be placed down your throat into your lungs. The tube may be uncomfortable, but you will be under anesthesia most of the time.

The anesthesiologist will put you under general anesthesia and you will not see or experience anything during the operation. During anesthesia, a transesophageal examination of the conduction system of the heart is performed (transesophageal cardiogram, in which an ultrasound device is inserted into the esophagus, broadcasting an image of the heart during surgery).

Step 2: Opening the Chest

The doctor will use a marker to mark the location of the incision on your chest. To access the heart, the doctor makes an incision along the chest, from the top of the rib cage to the navel. The incision passes through the sternum or breast bone. Recently, some surgeons have begun to use a minimally invasive surgery technique in which the incision is one-third the size of a normal incision.

Step 3: Cardiopulmonary bypass

Once your heart is visible, the surgeon will connect you to a heart-lung machine, which will act as your heart and lungs during surgery, supplying your body with oxygenated blood. To connect you to the heart-lung machine, your surgeon will insert a tube into your right atrium, which receives oxygen-free blood. Instead of being sent to the lungs for oxygenation, the blood enters the heart-lung machine for exchange carbon dioxide for oxygen. The blood then flows through the tube back into the aorta, from which the systemic circulation begins.

During the time you are connected to the heart-lung machine, your aorta will be clamped against the valve to prevent bleeding. To temporarily stop your heart, the surgeon will flush it with cold, salt water or medicine. The surgeon will then dip the heart in a solution to support it during the temporary loss of blood supply.

This procedure is necessary condition an operation that temporarily stops the heart while oxygenated blood continues to flow into your body. The procedure also reduces the risk of serious bleeding (hemorrhage).

Step 4: Removing the affected valve

Once the heart-lung machine is activated, the surgeon makes an incision in the aorta to remove the aortic valve. The surgeon will examine the aorta and aortic valve to determine the severity of the disease. If the valve is damaged, the surgeon will remove the valve septa. If the aorta is also affected, the surgeon will remove part of the aorta and replace it with a graft.

Step 5: Attaching the New Valve

After removing the affected valve, the surgeon uses special device will measure the size of the valve opening to determine the appropriate size of the artificial valve. As a rule, the valve with the maximum permissible large sizes for proper blood flow. The surgeon then checks to see if the size of the valve matches the size of the hole and then sews the valve back on.

Step 6: Disconnection from the heart-lung machine

After implanting the new valve, the surgeon will check its function to detect any possible bleeding. The surgeon then closes the aorta, removing air bubbles from your heart and restarting circulation. Once blood flow to the heart is restored, the heart will begin beating again. If the heartbeat is irregular (fibrillation), the surgeon uses an electric shock to restore the heartbeat to normal.

Step 7: Closing the Chest

Once your heartbeat is restored, the surgeon will close your chest, sewing together the bones of the sternum (sternum) with steel wire large section. The surgeon will then place a suture to close the incision in the chest. In most cases, a visible surgical scar remains on the chest. The operation lasts on average from 2 to 5 hours.

Step 8: Postoperative Recovery

After surgery, you will be admitted to the intensive care unit. Once you come out of anesthesia, the breathing tube will be removed. The tube may be left in place for several days to remove excess fluid from your lungs. You will be able to consume solid food 24 hours after surgery, after 48 hours you will be able to get up and walk around a little. Your breasts will be sore for a while. Depending on your general condition, you will be discharged from the hospital 4 to 5 days after surgery, but your hospital stay may be extended to 9 days.
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The internal frame of the heart is represented by folds of the inner membrane, which are called valves. They are designed to differentiate the blood flow of the atria and ventricles, to help the heart chambers work alternately, thereby alternating work with rest. If the valves cannot perform their functions for some reason, then heart valve replacement (prosthetics) is performed.

If the heart valve malfunctions, the condition of the heart muscle worsens and forms. The function of pumping blood to the heart is impaired. Thus, there is stagnation of blood in different organs, for example, kidneys, liver. If drug treatment is not started in time, internal organs become exhausted, which leads to the death of the patient.

Valve dysfunction is a serious pathology, which in some cases is an indication for surgical intervention.

Different types of operations are used:

• plastic surgery, used for minor disorders of the heart valve;
• complete replacement of a valve whose functionality is seriously impaired.

The indication for prosthetic surgery should be serious damage to the heart valves, which causes Negative influence on the movement of blood through the vessels. Organic disorders heart functions develop, for example, due to streptococcal infection. Most often, as an infectious disease, causing complications on the cardiovascular system, is sore throat, tonsillitis,.

Basic clinical indications for heart valve replacement surgery:

• frequent loss of consciousness;
• chest pain;
• respiratory dysfunction;
• strong ;
• aortic stenosis in patients who have undergone bypass surgery;
• severe heart failure;
• and breathing during minor physical exertion;
• endocarditis of infectious origin.

Contraindications

Making a decision to perform an operation is within the competence of the attending physician, who takes into account the general state of health, the presence of chronic diseases, allergic reactions for drugs and so on.

Contraindications to heart valve replacement surgery are as follows:

• ischemic or;
• ARVI;
• increased body temperature;
• endocrinological disorders;
• lung diseases;
• others.

Currently, there are the following types of heart valve prostheses:

• mechanical;
• biological.

Mechanical There are two types of heart valves: ball valves and hinged valves. The first subtype has not been used since the seventies of the twentieth century. The second, based on bicuspid hinged prostheses, is considered the most modern.

Biological heart valve is made from pig heart for people with increased level platelets when there is a risk. This type of prosthesis is also called xenografts.

Mechanical prostheses are susceptible to the appearance of clots on the valve leaflets, which causes thromboembolism of the pulmonary artery, stroke, thrombosis of the artery of the extremities with subsequent amputation. Due to the high degree of risk in older patients, it is recommended to undergo prosthetic valve replacement with a biological valve.

Biological prostheses are not perfect, since recurrent valve pathology is possible.

The service life of prostheses is up to fifteen years, provided there are no complications. When the period expires, the valve is changed during a second operation.

Preparation

As a result of confirmation of heart disease in the patient, a decision is made to urgently about the operation. For additional examination The patient is sent to the cardiac center and the date of the operation is determined. The patient can contact the health department at his place of residence with an application for a quota. This issue is traditionally resolved no later than twenty days.

Preparation for heart valve replacement surgery includes collecting necessary documents. This event very important and requires attentiveness on the part of the patient and his loved ones.

The list of documents that the attending physician will provide is as follows:

• ID card, passport;
• medical insurance policy;
• pension certificate;
• referral for surgery with comments from the attending physician;
• description of the patient’s condition after the last hospitalization with the results of laboratory tests;
• results, cardiogram;
• description of daily monitoring of cardiogram and blood pressure;
• chest x-ray;
• load test results;
• conclusions of an otolaryngologist, gynecologist, infectious disease specialist, dentist, urologist.

The operation is performed under general anesthesia, the day before the patient is given sedatives to stabilize his emotional state.

The operation to replace the heart valve is performed on the first day of hospital treatment or every other day when the operation is planned to use a heart-lung machine.

Once the patient is under anesthesia, doctors incise the skin and sternum longitudinally. The next step is to cut the left atrium (during prosthetics) or the aortic wall (during aortic valve replacement). The prosthesis is secured with sutures, and the incision site is sutured.

A necessary manipulation is the application of electrodes to stimulate the heart for some time after the operation. The wound is sutured, and wire sutures are used for better fusion of the edges of the sternum.

The duration of the surgical procedure is about 3 – 6 hours, and the hospital stay is up to 4 weeks.

Immediately after the operation, the patient is transferred to the intensive care unit, artificial ventilation lungs until the condition is completely stabilized.

Currently, it is practiced to perform operations without a typical incision of the sternum.

Endovascular prosthetics is a successful alternative to open surgery. Apply to patients who have contraindications to the traditional method.

Price

Almost always, heart valve replacement surgery is performed free of charge, since quotas are provided under the compulsory medical insurance system. It happens that for various reasons it is impossible for a patient to receive help from the Russian healthcare system. In this case, you can pay from your own funds.

The total cost of a heart valve replacement operation consists of the cost of surgery, prosthesis, and the postoperative period. The total amount ranges from ninety to three hundred thousand rubles. A complex operation, for example, simultaneous replacement of the pulmonary valve and aorta, tends to approach the maximum price.

In the Russian Federation, such operations are carried out in all major cities and are quite affordable for patients.

Complications

Any operation does not exclude complications. It depends on various reasons: from the qualifications of the surgeons, the general health of the patient, and so on. Postoperative complications are practically minimized, since the patient is carefully prepared for this procedure.

The most serious and unpredictable consequences prosthetics can cause thrombosis. To avoid such complications, antithrombotic therapy is carried out by introducing anticoagulants into the body. A popular one is heparin, which is administered subcutaneously immediately after surgery. Long-term preliminary treatment significantly reduces thrombus formation.

One of unpleasant complications called the development of endocarditis infectious etiology. This can be avoided by taking antibiotics in the postoperative period.

Lifestyle

After heart surgery, a person must correct some aspects.

Lifestyle after heart valve replacement surgery is subject to the following rules:

• monthly visits to the doctor in the first postoperative year, and twice a year thereafter;
• systematic use of medications;
• treatment of residual manifestations of heart failure;
• competent regulation of work and rest schedules;
• strict adherence to a diet with limited salt, smoked foods, and so on;
• rejection of bad habits.

The patient’s future quality of life depends on compliance with postoperative rules. The prognosis for heart valve replacement surgery is usually favorable. The operation significantly prolongs a person’s life, changes it in better side. Timely contact with specialists reduces the risk of complications.

Damage to the valvular apparatus of the heart is a very common pathology. Insufficiency, stenosis, or combined damage to any valve may occur. Most effective method treatment is surgery. The operation has its own indications and limitations, and its implementation is associated with a certain risk of a complicated course.

The function of the valve apparatus of the heart is to direct blood flow in the right direction. There are 4 valves located in the heart:

• mitral;
• tricuspid;
• aortic;
• pulmonary.

Location of heart valves

They all close during systole, which stops blood flow, and open during diastole. The valves can be located between the atrium and the ventricle or between the ventricle and the main vessel.

When is surgery necessary?

Heart valve replacement is necessary if it is dysfunctional. Surgery is indicated when the symptoms of the disease affect the quality of life and reduce physical activity.

The indication for this is the presence valve disease in the stage of decompensation.

This condition is usually accompanied by the following symptoms:

• shortness of breath during exertion or physical work;
• pain in the chest area;
• night cough;
• disturbance of consciousness.

Surgery can be performed on any valve. At combined lesion All dysfunctional valves are replaced.

Types of valves used

For prosthetics, 2 types of prosthesis can be used: artificial valve and biological.

The choice of material for the operation is determined by several factors:

• patient's age;
• risk of developing bacterial complications;
• the presence of thrombosis, thrombophlebitis, varicose veins;
• concomitant pathology.

An artificial prosthesis is more often used to treat young patients. First of all, this is due to the fact that the artificial material will last longer and there will be no need for repeated intervention.

Another advantage of an artificial prosthesis is the lower risk of infectious complications. Bacterial endocarditis is extremely rare when an artificial valve is used. The main disadvantage is high risk thrombus formation, therefore, when using an artificial prosthesis, it is necessary to take anticoagulants for life.

Biological prosthesis is used mainly for elderly patients. The most commonly used prostheses are made from porcine endocardium. The average wear-out period is 10-15 years; after this time, repeated intervention is required.

The main advantage of a biological prosthesis is the low risk of thrombosis.

Blood clots form much less frequently on biological material. Accordingly, there is no need to take drugs that have antiplatelet and anticoagulant effects for life. Main disadvantage biological valve– high probability of bacterial flora joining.

Preparation and contraindications for the procedure

Since the operation is performed under general anesthesia, it is forbidden to eat food 12 hours before the appointed time.

You must first undergo an examination, which is a component preoperative preparation. It includes recording an electrocardiogram and a chest x-ray. In addition, an echocardiogram must be performed before the operation.

With help this method valve damage, degree of compensation and heart failure can be assessed. The doctor also collects an allergy history, that is, indications of which medications or substances the patient is allergic to.

On the day of the operation, sedation is performed, that is, the patient is given sedatives. The patient is then taken to the operating room and undergoes further preparation.

There is a need for intervention certain contraindications. If they are present, prosthetics are prohibited. They are usually associated with the presence acute conditions, in which surgery under anesthesia is associated with high mortality.

Surgery is contraindicated in the presence of the following conditions:

1. Acute myocardial infarction.
2. Ischemic or hemorrhagic stroke.
3. Chronic cardiovascular dysfunction in the decompensation stage.
4. Acute respiratory failure.

Exacerbation of chronic diseases is relative indication. The patient cannot be operated on until the remission phase begins.

Thus, treatment is carried out first somatic disease, and after cupping acute period surgery is scheduled.

Also a temporary contraindication is the presence infectious process any localization. For bacterial inflammation, antibiotics are prescribed, and only after the symptoms of infection have completely disappeared, surgery is prescribed.

How does the replacement work?

Heart surgery is performed under general anesthesia. How is prosthetics performed?

1. A skin incision is made in the sternal area, opening the chest.
2. The affected valve is then removed and replaced with a prosthetic valve.
3. After replacement, the postoperative wound is sutured.

This principle is used to perform open surgery to install any prosthesis. The differences in surgical intervention are only in where the pathology is localized.

Aortic valve

The aortic valve is located between the left ventricle and the aorta. During surgery, the heart surgeon removes the diseased valve. Then it is replaced with a prosthesis.

Mitral valve

The mitral valve is located between the left atrium and the ventricle. The surgical technique is the same as for installing an aortic prosthesis. The differences lie in the location of the valve removal and its replacement with a new prosthesis.

Possible complications

All complications that may arise after surgery are divided into early and late. Early complications include:

• postoperative bleeding;
• pain syndrome.

Later ones include the development of the following conditions:

• infective endocarditis;
• thrombosis;
• sepsis.

The risk of complications depends on the type of prosthesis used. The use of a biological valve is associated with a high risk of bacterial endocarditis. This is a condition that is characterized by the ingress of pathological microorganisms onto the installed prosthesis. The danger of this disease is that bacteria can spread throughout the body through the bloodstream.

The use of a mechanical prosthesis carries a high risk of thrombosis.

Rehabilitation period

After the operation, a rehabilitation period begins, which largely determines the outcome. During the recovery period, you need to follow a diet, take prescribed medications, and adhere to a healthy lifestyle.

Diet

One of the components of the postoperative period is diet. The diet is determined, first of all, by the duration of the operation. In the early postoperative period It is recommended to consume liquid and semi-liquid foods; in the future, the range of permitted products will expand. In the late postoperative period, it is recommended to adhere to the following nutritional principles:

It is recommended to eat small portions, but often (5-6 times a day). All nutritional recommendations are general and aimed at improving the health of the body. Compliance proper nutrition increases the likelihood of recovery and favorable outcome several times.

Physical exercise

After the operation, heavy loads are completely eliminated. In the first few weeks you need to follow bed rest. In the future, it is recommended to therapeutic exercises, which is of a general strengthening nature. It is recommended to walk more, do yoga, and swim. It is forbidden to perform heavy physical work, play sports professionally.

Taking medications

In the postoperative period, medications are prescribed. What medications are needed will depend on the type of valve. If a mechanical valve was used, lifelong prescription of anticoagulants and antiplatelet agents is necessary.

Most often, an indirect anticoagulant is prescribed, for example, Warfarin. When taking it, you need to regularly monitor the state of the blood coagulation and anticoagulation systems. For this purpose, a coagulogram is prescribed. Drugs with antiplatelet effects can also be used:

1. Aspirin.
2. Clopidogrel.

Immediately after surgery, antibacterial agents are prescribed. This prevents the development of infective endocarditis. Subject to availability concomitant pathology Other drugs may also be prescribed. The treatment regimen is selected individually by a cardiologist.

After surgery, a person’s lifestyle changes. Before any invasive intervention, antibiotic prophylaxis must be taken. This helps prevent the development of infective endocarditis. You need to take antibacterial agents before any other surgery, tooth extraction, or invasive procedures.

Forecast

The prognosis for the operation is relatively favorable: the symptoms of the disease disappear, signs of heart failure decrease, and the quality of life improves.

The duration of the asymptomatic period depends on several factors: the type of prosthesis, the presence of concomitant pathology, and lifestyle. If complications develop, the prognosis is less favorable.

Heart valves are one of the important elements cardiac frame - they are needed to control the amount of blood in the ventricles. Over time, some of them may weaken or cease to perform their functions due to previous diseases. In this case, the heart valve will need to be replaced. The use of special prostheses opens up the possibility of full life. Modern technologies allow you to install a heart valve with minimal harm to health. Read more about what types of prostheses there are, and how the valve is replaced, later in the article.

Comparison of a healthy and diseased organ

The reasons why heart valve replacement is required can vary. In general, when an organ weakens, internal hemodynamics are disrupted - this type of disorder leads to accelerated aging of the muscle and all related problems. Timely replacement of heart valves will preserve its condition and at the same time solve the hemodynamic problem.

Plastic

Depending on the type of lesion, either plastic surgery or a full replacement may be required. The essence of the first is that the elasticity of the sash is restored with the help of a special ring. Having such support, the surgeon processes the valve itself. The result is minimal intervention.

The use of prostheses is a necessity only if the organ itself is completely unsuitable for restoration. This type of heart valve replacement is fraught with some consequences, but sometimes it is the only way out. If a heart valve is damaged, surgery to replace it is vital!

Diagnoses after which a prosthetic procedure is necessary:

1. Aortic valve stenosis. In this case, the patient experiences shortness of breath, chest pain and, sometimes, fainting.
2. Heart failure. Symptoms include shortness of breath even at rest, swelling of the limbs and face, and mitral valve stenosis.
3. Endocarditis. Provokes damage to the valves.

You need to talk to your doctor about whether to perform valve prosthetics or simply make a correction on the valve after passing all necessary tests and completing research.

What does a prosthesis look like?

In any case, if plastic surgery of the aortic valve or any other valve is required, preference will be given to it. This operation does not take much time and involves a small foreign body, which reduces the likelihood of rejection by the body. Important! Using a quality mitral valve prosthesis can reduce the risk of complications.

What are the valves: their functions in the work of the heart

The valves are a kind of checkpoints through which blood is driven into the atria. They have the following types:

• aortic – connects the aorta and left ventricle;
• pulmonary (pulmonary) – connection of the right ventricle with the trunk;
• mitral - left atrium and ventricle;
• tricuspid (tricuspid) - right atrium and ventricle.

Timely replacement of the aortic valve will prevent mixing of venous blood, and mitral valve replacement will prevent it from flowing from the ventricle into the atrium. An effect similar to the latter is observed when we're talking about about tricuspid valve replacement.

Any violation in their work leads to incorrect operation of the entire system. So, there is a possibility of mixing of blood, insufficient or excessive entry into the ventricles or atria.

Example of a modified organ

Timely operation heart valve replacement will not only eliminate the danger and unpleasant symptoms, but will also significantly prolong the patient’s life. Prosthetics of the tricuspid valve or any other valve is a complex undertaking that requires extensive knowledge from the surgeon. With the correct surgical method, the prognosis for recovery is more than favorable. Modern medicine considers not only transcatheter implantation of the aortic valve, but also a newer and less traumatic direction - endovascular aortic valve replacement.

It should be noted that the longer the patient hesitates to undergo surgery, the more likely deterioration of the condition. In pathological cases you will have to become a patient emergency care. Thousands of people die suddenly because the heart situation was not dangerous from the point of view of doctors and it is better to think about the most suitable options operations to replace the required valve on the heart. You need to understand that disturbances in the functioning of the heart should last less. Otherwise, there is a possibility of becoming disabled or even dying.

Different kinds mechanical prostheses

Operations: methods and features

Despite the fact that mitral valve replacement and standard tricuspid valve repair (usually according to De Vega) differ in the principle of work, the essence of the operation does not change.

The speed of the patient’s recovery depends on how the operation is performed. For example, surgery to replace the mitral valve can be performed minimally invasively, but it does not require opening the chest. In this case, the patient is immersed in deep anesthesia. This is the only way to carry out reconstruction.

Important! Prosthetics of the mitral valve or any other valve can be performed with either mechanical or biological implants. The latter require replacement every 15 years, as they are subject to wear. Mechanical ones are more durable, but thrombosis of the prosthesis is possible. In general, a bioprosthetic aortic or other valve is acceptable if the patient has no contraindications to this type of surgery. Otherwise, transcatheter aortic valve implantation should be performed with mechanical implants.

In general, replacement of the aortic valve without opening the chest area is possible using a method such as transcatheter aortic valve implantation.

Reconstruction of aortic valves: contraindications and preparation for surgery

No replacement operation is possible without a preliminary examination. In particular, the study is carried out:

• medical history;
• hereditary diseases;
• personal intolerance to drugs;
• current state of health.

Contraindications for both operations on the mitral valve and others are:

• thrombosis;
• deformation of several dampers;
• myocardial damage.

It is worth understanding that operations for defects of the tricuspid valve and others are always a roulette. Even the highest quality implants provide the right to disability, as they impose restrictions on certain aspects of life.

Before undergoing mitral or any other valve replacement surgery, the patient will be given the opportunity to become familiar with the procedure and rules that will need to be followed after heart surgery.

The patient himself can choose a prosthetic aortic or any other valve, in the absence of contraindications. To ensure that the organ being replaced does not cause inconvenience, it is better to entrust the choice to the attending physician.

The patient will be informed about how long the operation will take, as well as exactly how it will proceed. When the patient knows what transcatheter cardiac aortic valve replacement is, he experiences less stress.

In addition, the patient will learn what to expect immediately after mitral valve replacement:

• your head may hurt after anesthesia;
• required special diet after operation;
• there is temporary discomfort in the heart.

If necessary, the attending physician will answer questions about disability and other consequences.

Postoperative period: what will life be like immediately after reconstruction?

After surgery and successful restoration of the pump-motor function of the main muscle, doctors sew up the chest. In addition, sutures are placed only after bleeding has stopped.

Often the final stage is carried out using self-absorbing agents. But if the seams are made using steel tape, they need to be removed. As a rule, they are deleted when 9-12 days have passed, but they are taken into account individual characteristics body.

Rehabilitation after surgery involves the use of painkillers and control measurements. During this time, you will be in the intensive care unit. Control measurements concern the following:

• arterial pressure;
• pulse and general condition of the heart;
• urine - it will allow the medical staff to understand how the kidneys behave.

In the first hours after surgery, the patient will not be able to move or speak, which resembles disability, although this is not the case. All this will take about one to two hours. But in most cases, recovery occurs over a much longer period of time.

Life after surgery: possible complications and limitations

After any surgery on any heart valves, there is a chance of bleeding from anticoagulants. They are designed to ensure that the blood is not thick and passes through the circulatory system more easily. In addition, they prevent any clots from sticking to the walls of the heart or the replaced organ and thus forming a blood clot.

Often, surgery aimed at replacing the mitral valve can cause scar growth. This in any case leads to the formation of clots and blood clots, after which repeated surgery will be required. Otherwise, the patient may die.

In general, life after the surgical work of doctors is guaranteed, but there are some restrictions. To avoid unwanted complications The following recommendations should be followed:

1. Avoiding infectious diseases. It is better to talk with your doctor about what set of procedures to carry out.
2. Activity. Concerning physical activity, the doctor may advise you to move less or completely abandon certain activities and activities. It is allowed to lift light (up to 5 kg) things for 2 months after the implantation of a prosthetic organ.
3. Diet. You must eat strictly the food that your doctor allows. He can prescribe a specific diet or supplement an existing one. It is necessary to eat food so that the weight is within the limits agreed with the doctor.
4. Driving a car and returning to work processes. Everything here is strictly individual. You should definitely ask your doctor about the possibility of driving and returning to your workplace.
5. Smoking. Need to quit bad habit and not return to her. This is due to the fact that nicotine and tar in tobacco products block the pathways for oxygen to enter the heart and blood vessels.

Diet promotes speedy recovery

Important! If you notice that you are dizzy or have a feeling of discomfort, consult a doctor immediately!

An operation to replace a heart or aortic valve, like any other, has consequences. To avoid unnecessary consequences after replacing the valve, it is necessary to mandatory adhere to the above recommendations.